Provider Demographics
NPI:1629013883
Name:GRIGGS, JOHNNY RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:RAY
Last Name:GRIGGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 963135
Mailing Address - Street 2:
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73196
Mailing Address - Country:US
Mailing Address - Phone:405-947-8586
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:3300 NW EXPRESSWAY ST
Practice Address - Street 2:100 3135
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4418
Practice Address - Country:US
Practice Address - Phone:405-947-4001
Practice Address - Fax:405-948-6507
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK178232080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5039058OtherAETNA
OK5039058OtherAETNA